Investigation of The Effectiveness of Extracorporeal Shock Wave Therapy in Patients Diagnosed with Plantar Fasciitis: Comparison of Radial and Focus Applications.

The aim of the study was to investigate the effectiveness of radial and focus (extracorporeal shock wave therapy) ESWT treatment on pain, function and size of the calcaneal spur in patients with clinical and radiological diagnosis of plantar fasciitis. A total of 112 patients aged between 18 and 95 years, were divided into 2 groups; group 1, rESWT (2.4 bar 12 hz 2000 beats), group 2 received fESWT (0.14 bar 14 hz 1000 beats) 3 times a week for 3 weeks. All patients were evaluated using the Visual Analog Scale (VAS)-pain and Foot Function Index before and after the treatment, at 4 week and 12 weeks. Calcaneal spur size was measured radiographically in the patients before and after the treatment at the 12th week follow-up. According to our records, VAS scores were found to be similar between the groups before treatment and at follow-ups (all p > .05). In both groups, a significant decrease in VAS scores was found in the follow-ups compared to before treatment (p < .001). FFI total, pain, activity and disability scores were found to be similar between the groups before treatment and at follow-up (all p > .05). In both groups, a significant decrease in Foot Function Index scores was found in the follow-ups compared to before treatment (p < .001). Both of rESWT and fESWT were effective in plantar fasciitis treatment there were no significant difference between 2 modalities in long term.

The effects of functional electrical stimulation cycling on gait parameters in diplegic cerebral palsy: a single-blind randomized controlled trial.

PURPOSE: To investigate the effects of functional electrical stimulation cycling (FES-C) training in addition to conventional physical therapy on gait, muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic diplegic cerebral palsy. MATERIALS AND METHODS: Twenty children with diplegic cerebral palsy were randomly assigned to FES-C group (n = 10) or control group (n = 10). Subjects trained 3 days/week for 8 weeks. Control group received conventional physical therapy. The FES-C group additionally received FES-C training. The functional muscle test was used for muscle strength assessment. Vicon-3D system was used for gait analysis. Gross Motor Function Measure (GMFM-88) was used for motor function assessment and calorimeter was used for energy expenditure. Measurements were performed at the baseline, at the eight week and at the sixteenth week. RESULTS: Functional muscle strength, gross motor function, and energy expenditure improved more in the FES-C group after training and follow up (p < 0.05). There was no significant difference found between the changes in gait parameters of the two groups after treatment and follow up (p > 0.05). Pelvic tilt while walking decreased after training in the FES-C group (p < 0.05). CONCLUSIONS: FES-C applied in addition to conventional physical therapy in children with diplegic cerebral palsy is more effective than conventional physical therapy for increasing functional muscle strength, improving gross motor function functions, and reducing energy expenditure.HighlightsFES-C improves lower extremity functional muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic dCP.The use of FES-C in combination with conventional physiotherapy methods may be beneficial in outpatients with spastic dCP.

Motor neuron disease in a patient with overlap syndrome (rheumatoid arthritis; systemic lupus erythematosus, Sjogren's syndrome).

Autoimmune rheumatic diseases have their own specific clinical presentation, and can affect multiple systems. Neurological involvement of autoimmune rheumatic diseases may involve both the central and peripheral nervous systems. Inflammation of neural tissue, autoantibody-mediated reactions, and small vessel vasculitis may be effective in the pathogenesis of neuropathy in autoimmune rheumatological diseases. Autoimmune rheumatic disease with pure motor neuron involvement is very rare in the literature. The case is here presented of a 58-year-old female patient who presented with the complaints of increasing pain and weakness in the extremities and was diagnosed with lower motor neuron disease and overlap syndrome. The patient was treated with cyclophosphamide, pulse steroid, hydroxychloroquine and intravenous immunoglobulin. After 3 months of treatment, a significant improvement was observed in the patient's clinical complaints and laboratory parameters. In conclusion, some patients with undiagnosed autoimmune rheumatic diseases may have neurological complaints. Clinicians should investigate patients with such neurological complaints for autoimmune rheumatic diseases.

The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain: a prospective randomized controlled study.

To evaluate clinical and ultrasonographic efficacy of high-intensity laser therapy (HILT) in patients with hemiplegic shoulder pain (HSP) accompanied by partial thickness rotator cuff tear (PTRCT). The study was designed as a prospective, randomized, controlled trial. Patients with HSP accompanied by PTRCT (n = 44) were randomly assigned to HILT and control groups. Both groups were treated with a multidisciplinary stroke rehabilitation and a therapeutic exercise program to the affected shoulder supervised by physiotherapists. In addition, HILT group received 3 sessions of the intervention per week for 3 weeks. Primary outcome measure was visual analogue scale (VAS) for pain. Secondary outcome measures were range of motion (ROM) of the shoulder joint, Shoulder Pain and Disability Index (SPADI), Brunnstrom Recovery Stage (BRS), Modified Ashworth Scale (MAS), Nottingham Health Profile (NHP), Functional Independence Measure (FIM), and ultrasonographic PTRCT size. Participants were assessed at pre- and post-treatment. A total of 41 patients completed the study. A statistically significant improvement was observed in VAS, ROM, FIM, SPADI, NHP, and PTRCT parameters in HILT group at post-treatment compared to pre-treatment (all P < 0.05). However, control group indicated significant improvement only in VAS, ROM, and SPADI parameters (all P < 0.05). When differences in clinical parameters at pre- and post-treatment assessment were compared between two groups, change in VAS, FIM, BRS, SPADI, NHP, and PTRCT in HILT group was significantly better than control group (all P < 0.05). HILT combined with therapeutic exercise seems to be clinically and ultrasonographically more effective in the treatment of patients with HSP accompanied by PTRCT than therapeutic exercise alone in the short term. Further studies are needed with long-term follow-up. CinicalTrials.gov Identifier: NCT04669405.

Comparison of Ultrasound-Guided Prolotherapy Versus Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized Clinical Trial.

This study aimed to compare the effectiveness of extracorporeal shockwave therapy (ESWT) versus dextrose prolotherapy on pain and foot functions in patients with chronic plantar fasciitis with a prospective randomized-controlled trial. A total of 29 patients in whom conservative care failed were enrolled for the study after the clinical and ultrasonographic assessment. The patients were randomly assigned to receive ESWT (ESWT group, n = 15) or dextrose prolotherapy (dextrose prolotherapy group, n = 14). ESWT group received 1800 to 2000 focused shock waves (session of 0.20-0.30 mJ/mm2 with a frequency of 4-6 Hz) followed by soft tissue 3000 to 3500 radial pulses (session of 1.8-3.0 bar with a frequency of 15-21 Hz). Dextrose prolotherapy group underwent an injection of 5 ml 15% dextrose solution with 2% lidocaine. ESWT and dextrose prolotherapy were repeated 3 times by 2 weeks apart. A 100-mm Visual Analog Scale (VAS) for overall and morning pain, Foot Function Index (FFI) and the Roles and Maudsley Scale score (RMS) were assessed at baseline, 6 weeks, and 12 weeks after the last intervention. Overall VAS, Morning VAS, RMS and FFI scores improved significantly in both treatment groups at 6 weeks and 12 weeks compared to baseline (p < .001). Comparison of changes in overall VAS, Morning VAS, RMS and FFI scores did not show a significant difference between the groups at each time point (p > .05) In our study dextrose prolotherapy and ESWT had similar effectiveness in patients with chronic plantar fasciitis who have not respond to conservative care. The results showed ESWT and dextrose prolotherapy were not superior to each other.

Rehabilitative management of post-acute COVID-19: clinical pictures and outcomes.

This study aimed to detect patients' characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O2) requirement and daily living activities were assessed before and after rehabilitation. Eighty-five patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81 kg/m2. The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99 days, while those who needed O2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain-Barré syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities.

The Effect of Sham Controlled Continuous Theta Burst Stimulation and Low Frequency Repetitive Transcranial Magnetic Stimulation on Upper Extremity Spasticity and Functional Recovery in Chronic Ischemic Stroke Patients.

OBJECTIVE: This randomized controlled study examined the effect of continuous theta burst stimulation (cTBS) and low frequency repetitive transcranial magnetic stimulation (rTMS) on upper extremity spasticity and functional recovery in chronic ischemic stroke patients. MATERIALS AND METHODS: Twenty chronic ischemic stroke patients were randomized into three groups as real rTMS group (n = 7), real cTBS group (n = 7) and sham cTBS group (n = 6), in which real rTMS with physical therapy (PT), real cTBS with PT and sham cTBS with PT were applied in 10 sessions, respectively. The evaluation parameters were assessed at pre-treatment, post-treatment and follow up at 4 weeks. RESULTS: Ten sessions of real rTMS or real cTBS combined with PT were found beneficial in motor functional recovery and daily living activities both at post-treatment and follow up at 4 weeks (p Ë‚ 0.05). In the sham cTBS group, functional improvement was not significant (p > 0.05). In addition, in the real rTMS group, elbow flexor, pronator, wrist flexor and finger flexor spasticity were significantly decreased; in the real cTBS group, significant decrease was observed in the elbow flexor and wrist flexor spasticity (p Ë‚ 0.05). In comparison with sham cTBS group, only in the real cTBS group, significant improvement was observed in the level of wrist flexor spasticity at follow up at 4 weeks (p Ë‚ 0.017). CONCLUSIONS: In this study, it was observed that real cTBS or real rTMS combined with PT provided improvement on upper extremity motor functions and daily living activities in chronic ischemic stroke patients, but improvement in spasticity was limited.

Response to Speech and Language Therapy According to Artery Involvement and Lesion Location in Post-stroke Aphasia.

PURPOSE: Aphasia is one of the most common complications after stroke and occurs in 21-38% of the patients during acute period. The present study aimed to investigate the response to speech and language therapy according to artery involvement and lesion location in patients with post-stroke aphasia. METHOD: The medical records of 107 patients with post-stroke aphasia (mean age, 58.8 ± 14.8 years) who were admitted to a single rehabilitation center for usual care after stroke were reviewed. Location of the ischemic lesion and involved artery was determined assessing the brain MRI of the patients. All the patients received 24 sessions speech and language therapy (3 days a week) as a part of 8-week rehabilitation program. Evaluation of the aphasia was performed with Gülhane Aphasia Test-2 (GAT-2) at baseline and at the end of the rehabilitation program. RESULTS: Baseline GAT-2 scores was significantly worse in patients with middle cerebral artery (MCA) involvement compared to patients with other artery involvements (p = 0.007). While the GAT-2 scores of patients with MCA involvement were improved significantly after speech and language therapy (p < 0.001), the changes in those with anterior cerebral artery (ACA) and posterior cerebral artery (PCA) involvements were not significant (p > 0.05). CONCLUSIONS: The present findings suggested that speech functions might be more affected in ischemic lesion of MCA and response to SLT might be better in patients with MCA involvement.

Sonographic Predictors in Patients with Hemiplegic Shoulder Pain: A Cross-Sectional Study.

OBJECTIVES: To evaluate the sonographic findings of soft tissues more comprehensively, to investigate the relationship between sonographic pathologies and clinical features, and to determine the predicted factors that may interfere with the most common sonographic findings in patients with hemplegic shoulder pain (HSP) . METHODS: Sixty-four consecutive stroke patients with HSP admitted to inpatient clinic were included in this cross-sectional study. Demographic, clinical, and sonographic findings were recorded. Patients were assigned to poor or good motor function groups according to the Brunnstrom motor recovery (BMR) stages. RESULTS: There were abnormal sonographic findings in 63 patients (98.4%). A significant reverse correlation was found between the sonographic grading and functional independence measure (p=0.005) and a positive correlation with energy level (p=0.044). The main risk factors were age for acromioclavicular joint degeneration, BMR stage for glenohumeral joint subluxation, subacromial-subdeltoid bursitis for partial-thickness rotator cuff tear, and Pittsburgh Sleep Quality Index for long head of the biceps tenosynovitis. CONCLUSION: Age, motor recovery, subacromial-subdeltoid bursitis, and sleep quality were the strongest predictors of different sonographic findings in HSP patients. Functional capacity and energy level are negatively affected by an increased number of abnormal sonographic findings. Therefore, sonographic evaluation of shoulder soft tissue lesions eventually might provide a more constructive rehabilitation approach to achieve optimal outcomes, particularly in elderly patients with poor motor function and sleep quality.

The short-term effect of ultrasound and peripheral nerve stimulator-guided femoral nerve block with phenol on the outcomes of patients with traumatic spinal cord injury.

STUDY DESIGN: A pre-post descriptive study. OBJECTIVES: To examine the immediate effects of ultrasound-guided femoral nerve block with phenol (UGFNBwP) in managing the lower limb spasticity of individuals with traumatic spinal cord injury (SCI). SETTING: Ankara, Turkey. METHODS: Nineteen patients with traumatic SCI presenting with lower extremity spasticity were treated with UGFNBwP. Modified Ashworth Scale of hip flexion and knee extension, functional independence measure motor subscale, difficulty of catheterization, hygiene score, spasm frequency, sleep quality, and patient satisfaction (PS) were measured in all patients prior to treatment, in the first week and second month. RESULTS: There was a statistically significant decrease in the Modified Ashworth Scale scores in the first week and second month compared to baseline (p < 0.017). Significant improvements were detected in functional independence measure motor subscale, DoC, HS, SF and PS at follow-up examinations compared to baseline (p < 0.017). No statistically significant difference in the SQ score was found. Patients reported no complications during the intervention and follow-up period. CONCLUSIONS: Ultrasound-guided femoral nerve block with phenol is an option worth considering to reduce spasticity and improve function in people with SCI.

Knee pain relief with genicular nerve blockage in two brain injured patients with heterotopic ossification.

BACKGROUND: Heterotopic ossification (HO) is the ectopic bone formation in non-osseous tissues. This study aimed to present two patients with traumatic brain injury (TBI) who had HO in knee joint and pain relief after genicular nerve blockage. Case 1: A 14-year-old patient with TBI was admitted with bilateral knee pain and limited range of motion. Physical examination and x-ray graphics revealed calcification which was diagnosed as HO. Ultrasonography (US) guided genicular nerve blockage was performed to both knees with 2 ml lidocaine and 1 ml betamethasone. VAS of pain was decreased to 30 mm from 80 mm. At 6-month follow-up, VAS of pain was still 30 mm. Case 2: A 29-year-old patient with TBI was admitted for rehabilitation. He had right knee pain and his pain was 80 mm according to VAS. Investigation revealed HO. US guided genicular nerve blockage was performed to the right knee and pain was decreased to 20 mm. DISCUSSION: US guided genicular nerve blockage can provide pain relief in HO and this technique may be effective and alternative for pain relief in patients with neurogenic knee HO to increase patient's compliance.

The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury.

OBJECTIVE: To investigate the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) on intractable neuropathic pain in patients with spinal cord injury (SCI). DESIGN: A single center, prospective, randomized, double-blinded, controlled study. SETTING: SCI rehabilitation unit of university rehabilitation center. PARTICIPANTS: Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012. INTERVENTIONS: Ten daily treatment sessions of real or sham rTMS (30 trains of 10-Hz stimuli for a duration of 5 seconds; a total of 1500 pulses at intensity equal to 110% of the resting motor threshold) was applied over vertex using a figure-of-8-shaped coil. OUTCOME MEASURES: Pain was assessed with visual analog scale (VAS) at baseline and 10 days, 6 weeks and 6 months after the treatment. Patients' satisfactions obtained using a 5-point Likert scale at 6 months. RESULTS: Both real and sham rTMS provided a significant reduction in the VAS scores (real rTMS group, P = 0.004; sham rTMS group, P = 0.020). Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS group. Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point (P > 0.05). CONCLUSION: Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo. However, middle-term (over 6 weeks) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size.

Evaluation of forward head posture and thoracic kyphosis in migraine.

BACKGROUND: The purpose of the current study was to investigate the forward head posture (FHP), thoracic kyphosis and their relationships between individuals with migraine and healthy controls using the DIERS Formetric 4D motion imaging system. METHODS: In this observational case-control study, a total of 39 migraine patients and 44 healthy subjects were enrolled. FHP and thoracic kyphosis were assessed by using the 4D Formetric DIERS system. The visual analogue scale (VAS) and Neck Disability Index (NDI) was used to evaluate neck pain and neck disability. Headache status were evaluated through Migraine Disability Assessment (MIDAS) and Numeric Pain Rating Scale (NPRS) questionnaires. RESULTS: The fleche cervicale (57.72 ± 13.72 mm vs. 40.00 ± 4.75 mm; p < 0.001) and kyphotic angle (57.39 ± 8.76° vs. 38.21 ± 5.67°; p < 0.001) were significantly higher in patients with migraine compared to control group. When NDI categories were compared, the migraine group showed significantly increase in the number of patients with moderate or severe disability (p < 0.001). A positive correlation was found between fleche cervicale and thoracic kyphosis (r = 0.71, p < 0.001). CONCLUSIONS: This study revealed that patients with migraine exhibited a greater FHP and thoracic kyphosis compared to the control group. A 3-dimensional objective measurement may be a reliable diagnostic tool to evaluate posture analysis in clinical practice in the future.

Radiation-induced lumbosacral plexopathy and pelvic insufficiency fracture: A case report of unique coexistence of complications after radiotherapy for prostate cancer.

Case reports of plexopathy after prostate cancer are usually neoplastic. Radiation-induced lumbosacral plexopathy and insufficiency fractures have clinical significance due to the need to differentiate them from tumoral invasions, metastases, and spinal pathologies. Certain nuances, including clinical presentation and screening methods, help distinguish radiation-induced plexopathy from tumoral plexopathy. This case report highlights the coexistence of these two rare clinical conditions. Herein, we present a 78-year-old male with a history of radiotherapy for prostate cancer who developed right foot drop, severe lower back and right groin pain, difficulty in standing up and walking, and tingling in both legs over the past month during remission. The diagnosis of lumbosacral plexopathy and pelvic insufficiency fracture was made based on magnetic resonance imaging, positron emission tomography, and electroneuromyography. The patient received conservative symptomatic treatment and was discharged with the use of a cane for mobility. Radiation-induced lumbosacral plexopathy following prostate cancer should be kept in mind in patients with neurological disorders of the lower limbs. Pelvic insufficiency fracture should also be considered if the pain does not correspond to the clinical findings of plexopathy. These two pathologies, which can be challenging to diagnose, may require surgical or complex management approaches. However, in this patient, conservative therapies led to an improvement in quality of life and a reduction in the burden of illness.

The effect of medium-tension bandage and stump stocking on residual limb maturation in earthquake survivors.

BACKGROUND: Residual limb maturation is a crucial stage in postamputation care. OBJECTIVE: It was aimed to examine the effect of medium tension bandages and stump stockings on postamputation stump maturation in patients who underwent lower extremity amputations. STUDY DESIGN: In this prospective observational study, patients who were earthquake survivors and had undergone emergency amputation of their lower extremities were included. METHODS: Medium-tension elastic bandage or personalized stump stockings were used for stump maturation. Residual limb volume was measured once a week for 3 weeks. RESULTS: The study included 23 patients and 29 amputated limbs. Because of the larger stump volume of transfemoral amputations and the higher number of these patients in the stocking group ( p < 0.001), the stump volume differed across groups before and during the follow-up ( p < 0.001). There was no difference in mean volumetric measurement between the bandage and stocking groups over time ( p = 0.272). Although the group interaction was significant (p < 0.001), the group × time interaction was not ( p = 0.306). CONCLUSION: Medium-tension bandages and stump stockings had a similar effect on postamputation stump maturation in patients with lower extremity amputations. So, depending on the patient's and physician's preferences, both procedures can be used for stump maturation.

Clinical properties and rehabilitation needs of earthquake survivors in a subacute rehabilitation setting.

BACKGROUND: This descriptive analysis examines the victims of the February 6, 2023, earthquakes in Kahramanmaras and Elbistan, Türkiye. It aims to detail the injury profiles related to neuro-musculoskeletal trauma, assess the rehabilitation needs of patients, and propose a comprehensive rehabilitation approach. METHODS: The study included patients injured in the Kahramanmaras-centered earthquake on February 6, 2023, who were transported to our hospital based on their rehabilitation needs. Data from patients treated at our hospital were recorded retrospectively. This included demographic information, accompanying pathologies, laboratory findings, rehabilitation programs, and treatments received during their hospital stay. Statistical analyses were conducted to examine the data. RESULTS: A total of 141 patients with musculoskeletal injuries were admitted due to injuries sustained from the earthquake. The mean age of the participants was 39.76 years, with a slight female predominance (56.7%). The majority of patients sustained injuries while trapped under debris (90.1%), with an average duration of 10 hours under rubble. Fractures were the most common form of injury (53.2%), predominantly affecting the lower extremities. Peripheral nerve injuries were present in 41.1% of patients, and amputations were observed in 30.5%. Complications included compartment syndrome (46.1%), crush syndrome (36.2%), and various infections. Pain was prevalent among patients, with somatic pain being the most reported type. Individualized rehabilitation programs were implemented, incorporating physical therapy, wound care, pain management, and psychosocial support. CONCLUSION: This study highlights the critical rehabilitation needs of earthquake survivors and emphasizes the importance of early and comprehensive rehabilitation interventions. Multidisciplinary rehabilitation programs were crucial in addressing medical issues, functional limitations, and psychological challenges faced by the survivors. The findings contribute to a deeper understanding of earthquake-related injuries and underscore the significance of well-coordinated rehabilitation strategies in disaster responses.

The effect of high-frequency repetitive transcranial magnetic stimulation on motor recovery and gait parameters in chronic incomplete spinal cord injury: A randomized-controlled study.

Objectives: This study aims to examine the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on gait parameters and lower extremity motor recovery in a more specific sample of individuals with chronic and traumatic incomplete spinal cord injury (iSCI). Patients and methods: This double-blind, sham-controlled, randomized study included a total of 28 individuals (20 males, 8 females; mean age: 35.7±12.1 years; range, 18 to 45 years) with chronic (>1 year) traumatic iSCI. The participants were randomly allocated to either sham rTMS group (n=14) or real rTMS group (n=14). We compared the groups based on the lower extremity motor scores (LEMS), the temporal-spatial gait measurements using three-dimensional gait analysis, the Walking Index for SCI-II (WISCI-II), and 10-m walking test at baseline, three weeks (post-treatment) and five weeks (follow-up) after the treatment. Results: The real rTMS group revealed a significant improvement in walking speed, LEMS score, and 10-m walking test after the treatment compared to baseline (p=0.001, p=0.002, and p=0.023, respectively). Changes in the LEMS score were significantly increased in the real rTMS group compared to the sham group at both three and five weeks (p=0.001 and p=0.001, respectively). No significant difference was observed in the other variables between the groups (p>0.05). Conclusion: Our study findings support the therapeutic effectiveness of rTMS on motor recovery in chronic iSCI. The rTMS can be used as an adjuvant therapy to conventional physiotherapy in the rehabilitation of patients with iSCI.

The effects of Robot-assisted gait training and virtual reality on balance and gait in stroke survivors: A randomized controlled trial.

BACKGROUND: Stroke survivors often experience balance and gait problems, which can affect their quality of life and independence in daily living activities. Robot-assisted gait training, such as Lokomat with virtual reality, has been found to be effective in improving gait and balance. However, the specific effects of each virtual reality application on balance and spatiotemporal parameters of gait are not yet established. This study aims to investigate the effects of different virtual reality applications on these parameters. RESEARCH QUESTION: What are the specific effects of each Lokomat augmented performance feedback application on balance and spatiotemporal parameters of gait in stroke survivors? METHODS: The study is a randomized controlled trial conducted with four groups: Control Group, Endurance Group, Attention and Motivation Group, and Activity Timing Group. All participants received six weeks of physiotherapy, and Lokomat groups had additional robot-assisted gait training with Lokomat for three days a week. The Endurance group used Lokomat with Faster, Attention and Motivation Group with Gabarello and Smile, and Activity Timing Group with Curve Pursuit, Treasures, and High Flyer applications. Various tests were used to assess walking and balance in the study (gait analysis, 6-minute walk test, 10-meter walk test, Berg Balance Scale, postural stability, and limits of stability). RESULTS AND SIGNIFICANCE: The study involved 56 male stroke survivors (mean age: 60.02 ± 6.83 years, post-stroke time: 238.88 ± 40.88 days). All groups improved walking speed and distance significantly, but Endurance was better (p < 0.001). Balance improved significantly in all groups, but Attention and Motivation was superior in Berg Balance Scale, postural stability, and limits of stability (p < 0.001). The selection of virtual reality applications during robot-assisted gait training according to rehabilitation goals is important for successful rehabilitation, as these applications may have varying effects on balance and walking.

Effect of yoga-based exercises on functional capacity, dyspnea, quality of life, depression, anxiety, and sleep of infected healthcare workers during the COVID-19 pandemic: A prospective clinical trial.

Objectives: The study aimed to investigate the effect of yoga-based exercises on functional capacity, dyspnea, quality of life, depression, anxiety, and sleep quality following coronavirus disease 2019 (COVID-19). Patients and methods: Forty-one COVID-19-infected healthcare professionals (35 females, 6 males; mean age: 39.7±6.5 years; range, 28 to 55 years) who were actively working during the subacute period were included in the prospective controlled study between March 2021 and September 2021. The participants were divided into two groups: the yoga-based exercise group (YBEG; n=26) and the nonintervention group (n=15). Besides routine recommendations, the YBEG performed stretching, relaxation, isometric strengthening, breathing, and meditation exercises of 60 min twice a week for eight weeks. Clinical outcome was measured with flexibility tests (shoulder flexibility and sit and reach tests), hand grip strength, 6-min walk test, dyspnea score, Beck Depression and Anxiety Inventory, Short Form 36 (SF-36) quality of life, Pittsburgh sleep quality index (PSQI), and the International Physical Activity Questionnaire (IPAQ) before and after eight weeks in both groups. Results: Beck anxiety scores, IPAQ scores, PSQI, SF-36 pain, and social functioning subparameters were positively statistically significant in the YBEG (p<0.05). The only parameter found to be insignificant in time and between groups was the SF-36 mental health subparameter (p>0.05). In addition, the YBEG had significant improvements in muscle strength, flexibility, functional capacity, physical activity level, quality of life, anxiety, depression levels, and sleep scores between before and after the eight-week intervention period (p<0.05). Conclusion: Yoga programs have led to an increase in functional capacity and physical performance, a decrease in anxiety and depression complaints, and an increase in the quality of life in healthcare professionals who were in the process of returning to work during the post-COVID-19.